Daniel Sudin Varghese, Vani Deven Harshad, Smith Andrew Melvin, Hill Quentin Antony, Menon Krishna Viswanath
Department of HPB and Transplant, Ground Floor, Lincoln Wing, St James's University Hospital, Leeds, United Kingdom LS97TF.
JOP. 2010 Jan 8;11(1):72-4.
To highlight a rare presentation of acute lymphoblastic leukaemia.
A 39-year-old man presented with a 4 month history of weight loss and a 6 week history of upper abdominal pain radiating to the back with nausea and vomiting. Liver function tests showed an obstructive picture, full blood count was normal and on computerised tomography there was diffuse enlargement of the pancreas, with dilatation of the common bile duct and intra hepatic biliary radicles. Four weeks after presenting, the white cell count became elevated with blasts on the blood film and bone marrow biopsy revealed a precursor B cell acute lymphoblastic leukaemia. After induction chemotherapy his jaundice resolved, the pancreatic mass reduced in size and he is now in a complete remission.
Acute lymphoblastic leukaemia may mimic common causes of a pancreatic mass such as adenocarcinoma and should be considered as part of the differential diagnosis when atypical features are present.
强调急性淋巴细胞白血病的一种罕见表现。
一名39岁男性，有4个月体重减轻病史，6周上腹部疼痛并放射至背部，伴有恶心和呕吐。肝功能检查显示梗阻性表现，全血细胞计数正常，计算机断层扫描显示胰腺弥漫性肿大，胆总管及肝内胆管分支扩张。就诊四周后，白细胞计数升高，血涂片可见原始细胞，骨髓活检显示为前体B细胞急性淋巴细胞白血病。诱导化疗后，他的黄疸消退，胰腺肿块缩小，目前处于完全缓解状态。
急性淋巴细胞白血病可能类似胰腺肿块的常见病因如腺癌，当出现非典型特征时应作为鉴别诊断的一部分予以考虑。
